CAJ | 학술논문

背景：跟腱位置表浅，皮肤血供较少，开放性损伤后污染较重，难以彻底清创，修复后易发生感染及局部皮肤缺损、肌腱外露，传统换药治疗效果不佳。 　　目的：探讨腓肠神经营养血管逆行皮瓣联合负压封闭引流技术治疗跟腱断裂术后感染伴皮肤缺损的临床经验。 　　方法：选择2009至2012年佛山市第二人民医院收治的13例跟腱断裂术后感染、皮缘坏死患者，其中男8例，女5例；年龄25-65岁；跟后皮肤缺损4 cm×5 cm-7 cm×6 cm。经过扩创、负压封闭引流治疗，待创面肉芽组织新鲜、感染控制后，跟后皮肤缺损采用自体腓肠神经营养血管逆行皮瓣修复。随访观察创面愈合情况。 　　结果与结论：13例患者移植皮瓣均成活，创面均获得一期愈合。随访9-14个月，移植皮瓣无继发坏死、感染，皮肤质地及弹性良好，蒂部无明显臃肿。随访后6个月时，采用美国足踝外科学会评分系统评价踝关节功能显示优良率为90%。提示运用负压封闭引流技术可有效控制感染，腓肠神经营养血管逆行皮瓣为跟腱外露提供了良好的覆盖，皮瓣外观、血运、质地、弹性佳，局部无明显瘢痕挛缩，踝关节功能恢复良好。
배경：근건위치표천，피부혈공교소，개방성손상후오염교중，난이철저청창，수복후역발생감염급국부피부결손、기건외로，전통환약치료효과불가。 　　목적：탐토비장신경영양혈관역행피판연합부압봉폐인류기술치료근건단렬술후감염반피부결손적림상경험。 　　방법：선택2009지2012년불산시제이인민의원수치적13례근건단렬술후감염、피연배사환자，기중남8례，녀5례；년령25-65세；근후피부결손4 cm×5 cm-7 cm×6 cm。경과확창、부압봉폐인류치료，대창면육아조직신선、감염공제후，근후피부결손채용자체비장신경영양혈관역행피판수복。수방관찰창면유합정황。 　　결과여결론：13례환자이식피판균성활，창면균획득일기유합。수방9-14개월，이식피판무계발배사、감염，피부질지급탄성량호，체부무명현옹종。수방후6개월시，채용미국족과외과학회평분계통평개과관절공능현시우량솔위90%。제시운용부압봉폐인류기술가유효공제감염，비장신경영양혈관역행피판위근건외로제공료량호적복개，피판외관、혈운、질지、탄성가，국부무명현반흔련축，과관절공능회복량호。
BACKGROUND:Achil es tendon is placed in superficial position, and blood supply is few offered. Open injury leads to severe contamination, which is difficult to remove by complete debridement. Fol owing the repair surgery, the infection, local skin defects and tendon exposure occur, change of dressing obtains unsatisfactory outcome. OBJECTIVE:To investigate the clinical application of vacuum sealing drainage technique combined with reversed sural neurovascular pedicle flap to treat post-operative infection and skin of Achil es tendon. METHODS:From 2009 to 2012, 13 patients with post-operative infection and skin of Achil es tendon were selected from the Second People’s Hospital of Foshan City, China, including 8 males and 5 females. The age of the involved patients was 25-65 years old. The accompanied soft tissue defects after ankle were ranged 4 cm×5 cm to 7 cm×6 cm, and repaired with repeated debridement and vacuum sealing drainage technique, until the wound granulation tissue was clean and the infection was control ed. The skin defects were repaired by reversed sural neurovascular pedicle flap. The healing of the wound was observed during fol ow-ups. RESULTS AND CONCLUSION:Al the patients were fol owed for 9-14 months. Al the flaps survived completely in 13 patients, with good appearance, blood supply and texture. No secondary necrosis and infection was found. According to the AOFAS evaluation, the excel ent rate of ankle joint function was 90%at post-operative 6 months. The wound infection can be effectively control ed by vacuum sealing drainage. The reversed sural neurovascular pedicle flap could provide a good covering for the exposed tendon and a flap with fine appearance, blood supply, texture and elasticity for soft tissue defects. The recovery of ankle joint functions is excel ent, without local cicatricial contracture.